Shorter Versus Longer Courses of Antibiotics for Infection in Hospitalized Patients: A Systematic Review and Meta-Analysis

J Hosp Med. 2018 May 1;13(5):336-342. doi: 10.12788/jhm.2905. Epub 2018 Jan 25.


Background: Infection is a leading cause of hospitalization with high morbidity and mortality, but there are limited data to guide the duration of antibiotic therapy.

Purpose: Systematic review to compare outcomes of shorter versus longer antibiotic courses among hospitalized adults and adolescents.

Data sources: MEDLINE and Embase databases, 1990-2017.

Study selection: Inclusion criteria were human randomized controlled trials (RCTs) in English comparing a prespecified short course of antibiotics to a longer course for treatment of infection in hospitalized adults and adolescents aged 12 years and older.

Data extraction: Two authors independently extracted study characteristics, methods of statistical analysis, outcomes, and risk of bias.

Data synthesis: Of 5187 unique citations identified, 19 RCTs comprising 2867 patients met our inclusion criteria, including the following: 9 noninferiority trials, 1 superiority design trial, and 9 pilot studies. Across 13 studies evaluating 1727 patients, no significant difference in clinical efficacy was observed (d = 1.6% [95% confidence interval (CI), -1.0%-4.2%]). No significant difference was detected in microbiologic cure (8 studies, d = 1.2% [95% CI, -4.1%-6.4%]), short-term mortality (8 studies, d = 0.3% [95% CI, -1.2%-1.8%]), longer-term mortality (3 studies, d = -0.4% [95% CI, -6.3%-5.5%]), or recurrence (10 studies, d = 2.1% [95% CI, -1.2%-5.3%]). Heterogeneity across studies was not significant for any of the primary outcomes.

Conclusions: Based on the available literature, shorter courses of antibiotics can be safely utilized in hospitalized patients with common infections, including pneumonia, urinary tract infection, and intra-abdominal infection, to achieve clinical and microbiologic resolution without adverse effects on mortality or recurrence.

Publication types

  • Meta-Analysis
  • Research Support, N.I.H., Extramural
  • Systematic Review

MeSH terms

  • Anti-Bacterial Agents / standards*
  • Anti-Bacterial Agents / therapeutic use*
  • Anti-Infective Agents / standards*
  • Anti-Infective Agents / therapeutic use*
  • Hospitalization
  • Humans
  • Pneumonia / drug therapy*
  • Time Factors


  • Anti-Bacterial Agents
  • Anti-Infective Agents